COVID-19: What do we do now?
BACP Workplace, April 2020

On 16 March, Boris Johnson, Prime Minister held the first daily briefing to the nation on how the UK would tackle the coronavirus pandemic. One week on,* Nicola Banning talks to practitioners about their organisation’s early response.

We are living through the threat from coronavirus in real time, along with our clients, families, organisations, the nation and other countries across the world. Behind essential frontline workers such as NHS staff, emergency services and education staff, there’s an army of workers who’ve been shown to be critical in keeping our society working, and who cannot shift to homeworking. They include shop workers, lorry and delivery drivers, cleaners, carers, social workers, local authority planners, environmental health and critical infrastructure workers to name a few.

Wherever we are, every aspect of our lives, and those of our families, clients and organisations, are changing for the long haul. Complex and potentially life-threatening decisions are being made, often in a heightened state of anxiety and fear. As one therapist in an organisation with nearly 10,000 staff said: ‘We are in a live experiment. We have to make a decision at work and then 20 minutes later, someone says, “Yes, but what about…” and what they’ve noticed is vital and we have to stop and listen and start again.’

After the initial shock, people have quickly mobilised and are forming plans as we prepare for long-term periods of self-isolation. Speaking on Radio 4, Professor Susan Michie, Director of the Centre for Behaviour Change at the University of London, said
that people will need three things:

Good financial and practical support
Clear communication and social support and
Clarity about what we are being asked to do.¹

One crucial lesson being learnt is the importance of collaboration between citizens and official institutions or between different parts of the organisations, bringing people together (physically or virtually) to work strategically and focus minds on the task ahead. It’s new to most of us, the territory is unknown and there is no map. What we do have are experienced practitioners who are specialists in working with change, anxiety and trauma in organisations and who can share their early responses of how they and their workforce are adapting to the threat of COVID-19.

Coming together – staying apart

Across the UK, offices and buildings were hastily closed down and footfall restricted. In days and, in some cases hours, service managers shifted teams of workplace counsellors from providing face-to-face sessions to online and telephone provision. ‘What’s helped is that as a service we had a Business Continuity Plan in place before the crisis, and an incredibly flexible staff counselling team,’ said Nick Wood, Senior Wellbeing Advisor at Gloucestershire County Council.

Psychological preparation helps, but it’s still an enormous shift and takes its toll. One counsellor walking away from their place of work for the last time, unable to hug her colleagues, said: ‘I was overwhelmed with sadness. I don’t know when we’ll go back or even if we’ll all go back. I look at the lists of people vulnerable to the virus, and then I realise, “I’m asthmatic and I’m one of them.” I’ve never been in the trauma with my clients, but I am now.’

Slow things down

At the University of Leeds, where over 9,500 people are employed, the planning has been on a vast scale, involving every single department working collaboratively: ‘There’s a shared sense at this critical time that if you know something useful, you share it’, says Nicola Neath, Staff Counsellor. And while crucial decisions are being made at speed, regular communication and debriefing are essential, says Julie Hughes, whose service Mind Matters Counselling also provides counselling to the university’s staff: ‘I just need 20 minutes to check in with my business partner at the end of each day. It helps to keep me grounded while I’m experiencing what everyone else is also going through.’

Understandably, people are anxious and feeling under threat, at a time when they’re needed to make good decisions at great speed: ‘It’s crucial that before every meeting, whether online or face to face, that either I or a colleague just asks everyone to stop and to take a moment to centre themselves and take a breath. Everyone appreciates it and they are always better for it afterwards,’ says Nicola Neath.

Keeping people regulated and helping them to get their thinking brains back online is a crucial skill at this time. This is particularly so if we are working with the category of essential workers, whose professional lives are now not only less predictable, but who are also at higher risk because of their exposure to the virus. Based on discussions with colleagues, I’ve compiled some thoughts on how we can best serve our organisational clients with the task ahead.

A new approach to provision

Flexibility: This is no time for rigidly adhering to the 50/60-minute session - it’s not necessarily what our clients find helpful right now, nor do many have the time for it. Services need to consider how we can be flexible for our staff. We must be aware that we are now supporting staff who may be working at home, under pressure, in spaces that aren't fit for purpose. Indeed, these same factors may also apply to ourselves. There are further financial worries for self-employed therapists, some of whom report clients dropping out of sessions because they are time starved and it’s simply another thing ‘to do’.

Practical support: Different times call for different measures and we cannot underestimate the importance of small acts of kindness, check-ins and practical support. At the University of Leeds, the service is looking at a new way of working, including ‘the little and often’ approach. Instead of one long session, clients could be offered shorter, regular, 15-minute check-ins, either via phone or online, but the clients will have autonomy and choice.

Grounding: Moving sessions online or via the phone, means that we must still support clients and help to keep them grounded. The service at Leeds is briefing the team of counsellors to start online counselling sessions on Zoom in similar ways to the face-to-face sessions. This also applies to the internal meetings being held online: ‘eyes down for centring yourself – and then when you’re ready, eyes up and smile at the person in front of you.’

Vulnerable clients: We know that good work is beneficial for us, but what happens if our staff are in an abusive relationship at home or have abusive neighbours? They are now at risk in their place of work, so how do we address this? It’s throwing up new dilemmas, which will demand creative responses and new boundaries. In therapeutic circles, prior to the PM's announcement about the need for restricting our movements, discussions were underway about how we could meet the need of clients in abusive relationships, eg by dog walking or parallel car park counselling (adhering to two-metre social distancing guidelines). This all requires further discussion in supervision with reference to BACP’s Ethical Framework for the Counselling Professions.²

Adapting your practice for COVID-19

At times like this, people in all sectors are being stretched to learn new skills, and it’s understandable that not all therapists will be confident or trained to work online. However, if you’re offering your services as an affiliate counsellor, there are certain things that you will be expected to know, says Julie Hughes, Case Manager at Mind Matters Counselling: ‘We have to be confident that the therapist is able to work proficiently on that platform, whatever it may be, with a client.’ She recommends the following:

Do your research
Make sure that you know what is involved if you are moving over to working online. Become familiar with the software, attend the free training sessions and watch the demonstrations to increase your confidence.
Practise
Put your new knowledge to the test and have meetings with colleagues, friends and family, using the platforms. Stress-test the systems for bugs and technological glitches. Consider how your working environment looks and what your clients will see when your session begins. If it’s not suitable, explore options for setting up a virtual counselling room in the background.
Contracting and insurance
Check out BACP’s website, where you will find current information and guidance related to COVID-19 for contracting with clients online/phone including regarding confidentiality. Check with your insurance company that your policy will cover you for working online.

BACP is partnering with Onlinevents to bring its members free access to resources for working online. Each week, there is a webinar, 'Coronavirus: Considering our responses and responsibilities', with Kate Dunn and Carole Francis-Smith, which is downloadable. One therapist switching to virtual working said: This webinar helped me to feel connected with my profession at a time when I really needed it. I was left supported and encouraged to try out new ways of working and surprised at how enabling it was.

What helps teams of counsellors?

I’m focusing on channelling my efforts into helping the team of counsellors who provide emotional and psychological support to local authority staff. Carers and counsellors are not always great at looking after their own needs – particularly in a crisis – and so my skills in critical incident stress management (CISM) are proving invaluable, both to my own ways of coping and to helping me to ground others as we all face an invisible threat to our emotional, physical and financial security.

Normalise: It’s normal to be experiencing disorientation and confusion, and my role is to ‘contain, ground, and educate’ in difficult circumstances, normalising the often overwhelming psychological, physiological and emotional responses to minor, moderate and severe threats to personal safety. The unique difference with COVID-19 is that I am also balancing supporting others with managing my own experience.

Innovate: We need to find new and creative ways to stay connected, but we are doing it at lightning pace. To different degrees, we are all on a steep learning curve, and in our team, we are shifting to using new platforms for working; and, because it’s unfamiliar, we are likely to do everything more slowly – so we need tolerance and kindness. However you do it, try to reassure, laugh, share resources, share skills and be available to each other.

Make a two-minute film: Instead of sending yet another text, I’ve been making a short film as a way of connecting with the team and saying ‘hello’. Be real, smile, tell them what you’re doing today, and ground yourself in what you know you are going to tackle today. One response was: ‘Sue, it’s so uplifting to see you and hear you this morning. Thank you!’

Reach out: In CI work, often the perceived level of support can be huge in terms of how people feel they can and will cope. Even if people don’t need the support – they know it is there. I am holding open the communication to the team in lots of different ways – the message is, I’m here if you need me – here if you don’t!

Model good practice: This is a time to turbo charge our self-care and follow the usual guidance we give to our clients. Manage your exposure to 24-hour rolling news (if you can), for example, check it twice a day, in the morning and evening, get fresh air, go for (dog) walks, do some yoga, light a candle – anything that soothes and helps you to regulate yourself.

Working with our communities

In Bristol, therapy provider Oasis-Talk is working closely with seven other charities led by Bristol Age UK to provide a range of practical and emotional support to older people. There is a COVID-19 helpline for anyone over 70 years of age, or between 50 and 70 with long-term health conditions, who need help with the delivery of food and prescriptions. For emotional support, people can choose between free, tailored support for coping with COVID-19-related anxiety, or conventional counselling support. In collaboration with other agencies, they are also providing support for staying active at home.

Vicki Palmer, CEO of Oasis-Talk, says: ‘The therapy profession has excellent listening skills and we know a lot about managing anxiety. If we can help people to reduce their anxiety, we will be helping them to strengthen their immune system, and we should be doing this wherever we can. So often, we focus on the individual in therapy and we don’t look nearly enough at the context around them; in the new world of COVID-19, it’s not an option; it’s absolutely essential that we look at the context. We will be letting our clients down if we don’t help them to make this shift in their own lives. We need to bring all their contexts into the therapy room because this is where their lives are lived. Their therapy aims to equip them to find ways of being that supports healthy interactions with others as well as with themselves.’

‘Our society has become so “me, me, me” – illustrated by the panic-buying in supermarkets; whereas, in other countries, that’s not been the case. One of the shadow sides of our profession, is the focus on individuality and self-interest. I hope that as a profession, we can mitigate against that and bring the client’s context into the therapy room. Looking ahead, I think that, post virus, our profession will be stronger if we all become more used to working systemically.’

Anne Scoging, Head of Counselling and Trauma Service, London Fire Brigade

If anyone knows about how an organisation can come through a traumatic incident, Anne Scoging, Head of Staff Counselling and Trauma Support at the London Fire Brigade, does. She explains:

‘Personally, I’m entering the COVID-19 crisis feeling calmer. My sense is that, as an organisation, we’re collectively calmer because we know what we’ve already come through together with Grenfell and we know what it is that we now need to do.

‘The attitude of my team is, “We can do this; we are robust and we will get through this.” It’s important that we all stay well informed, avoid misinformation and fake news and that we follow Government guidance with all our clients, without deviating from that. We are sharing information with staff about how we keep ourselves physically and mentally well.

‘That said, this virus is challenging for firefighters, who are used to being in very close proximity to each other, but who now need to keep their physical distance. By the very nature of their work, they are going to be exposed to the virus, and when firefighters have to self-isolate, it means staff are being asked to take on overtime, which is an extra risk to their health.

Compassionate leadership

'I am a great believer in post-traumatic growth, and I am beginning to see it organisationally - there are small, green shoots which are emerging, because we have already come through the crisis of Grenfell. We know that we have the practical skills and psychological skills to contribute to this emergency in whatever way we can.

There is a collective sense that we can be as strong and trustworthy as London needs us to be and that’s the message coming right from the top, from Andy Roe, our new Commissioner, who has used the ‘C’ word - compassion. His message is about compassion and trust - that’s the kind of organisation that we want to create at the London Fire Brigade. I think this will serve to galvanise our people: we will help the paramedics, or we will distribute personal and protective equipment, and we will do whatever we can to adapt and help London through this. As always, our team of counsellors will be there too, playing a crucial role.
Looking

Next in this issue

Looking ahead

The change cycle means that when the initial shock and anxiety subside, we must be ready to anticipate the next phase when people dip into sadness and depression. One colleague’s GP warned him that the counselling profession will have to get itself prepared for an epidemic of mental health need - and for that, we are going to need stamina and collaboration.

As we take up our role in responding to COVID-19, we will have to be resourceful, inventive, creative and informed. It’s positive that we can work virtually and keep our client and supervision work going, but Anne Scoging at the London Fire Brigade cautions us about the demands of virtual working: ‘It’s exhausting working this way, and while it’s tempting to offer that connection in our work, to our clients and our supervisees, it must not be that we overlook keeping all our other connections going, which can support us. Whatever it is, make sure that you are mindful of what you need, whether it’s an online yoga class, singing, drama or talking with friends and family,’ says Anne.

Closing thoughts

Despite the descriptions of us being a nation on a war footing and that, inevitably, we will face heavy casualties, there is much anecdotal evidence circulating that suggests people are already holding hope and finding connection, compassion and community in surprising places. As therapists, we are adept at finding light in the darkness and supporting others to find it too.

I'll give the last word to Vicki Palmer, Chief Executive of Oasis-Talk: 'COVID-19 is a wake-up call. It brings us all face to face with our own mortality and the mortality of our loved ones. We have to ask ourselves, what sort of a world do we really want to live in? Do we want to live in an individualistic world, or do we want to live in a world where we look out for each other and look after each other? We can choose where we put our energy, but it’s the collective effort that always enhances our own wellbeing. Two thought-provoking questions for our clients, ourselves and our wider systems, could be: how would you like the world to be when this is all over? And: how could you contribute to creating that world?’

*This article was written in late March

References

1 World at One. BBC Radio 4. www.bbc.co.uk/programmes/m000gc4z
2 www.bacp.co.uk/events-and-resources/ethics-and-standards/ ethical-framework-for-the-counselling-professions/